Table 3 Compensating for the reduced ability of people with dementia to self-manage: CMOcs, consensus statements and outcomes
CMOc | Consensus statements | Outcome | Operationalisation | |
|---|---|---|---|---|
CMOc4 | Context: cognitive impairment may limit the ability of people with dementia to comply with instructions and form habits Mechanism (resource): staff tailor the intervention (e.g. exercises) to the circumstances of people with dementia and embed it in their existing routines Mechanism (reasoning): intervention becomes routine and habitual Outcome: more successful rehabilitation can be achieved | Interventions should be based on goals set by the patient and carer | Agreed in round 1 (86–100%) | • Goal Attainment Scaling [91] (GAS) implemented • Compass of Life [92] included to assist in goal identification |
Therapists should work with service users to minimise the risk of falling, as this may improve confidence and enable realistic risk taking. | Falls risk assessment included | |||
Therapists should help the service user and caregiver to develop a meaningful programme of activities | • Assessment records personal preferences, routines, and priorities • Therapists develop programme of meaningful activities based on information gathered | |||
Therapists should undertake observed activities with the service user to facilitate new learning | Included in assessment | |||
Exercise interventions should be informed by evidence based formats such as the Otago programme but tailored to the circumstances of people with dementia and embedded in their daily life | Agreed in round 2 (69%) | • During training, staff are encouraged to use evidence-based formats creatively • Training also includes advice on creating programmes and embedding them into routines • Coloured paper provided for embedding strategies | ||
CMOc5 | Context: cognitive impairment may limit the ability of people with dementia to self-manage changes in circumstances Mechanism (resource): ongoing follow-up is provided Mechanism (reasoning): staff are able to reinforce previous interventions and adapt them to meet changing needs Outcome: improvements in mobility are sustained and new falls risks reduced | The total number of physiotherapy sessions available in the first 3 months (including sessions delivered by a support worker) should be 16, 20 or 24 | No consensus after 2 rounds (31–62%) | Implemented 2 assessment sessions and maximum 22 therapy sessions delivered by a mix of OT, physiotherapist and support worker |
The total number of occupational therapy (OT) sessions available in the first 3 months should be 3–4 | ||||
CMOc6 | Context: the burden on informal carers is high when caring for relatives or friends with dementia who are at risk of falling Mechanism (resource): carer support and education is provided Mechanism (reasoning): carer stress is reduced and skills increased Outcome: carers’ capacity to assist with the delivery of interventions increases | Carer stress should be routinely assessed | Agreed in round 1 (93–100%) | • Carer stress included in assessment • Training emphasises ensuring carers have capacity to be involved |
Therapists should facilitate caregivers, family and friends to adopt a positive approach to risk | • Training includes advice on carer education, including accepting ‘positive risk’ • Carer education leaflets provided for dissemination [93, 94] | |||
Intervention staff should be able to provide basic carer education & support, referring to other agencies as needed | Agreed in round 2 (77%) |